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Rheumatoid Arthritis — SCE Rheumatology MCQ

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EasyRheumatoid ArthritisRheumatoid ArthritisSCE Rheumatology

A patient with RA on Methotrexate 15 mg weekly has blood monitoring showing a white cell count of 2.8 x10^9/L (normal >4.0) and neutrophils of 1.2 x10^9/L. Which action is most appropriate according to BSR csDMARD monitoring guidelines?

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Correct answer: D — Withhold Methotrexate and repeat bloods in 2 weeks

BSR 2025 csDMARD monitoring guidelines recommend withholding Methotrexate if the WCC falls below 3.5 x10^9/L or neutrophils below 1.6 x10^9/L. Treatment should be withheld and bloods repeated; if counts recover, Methotrexate can be restarted at a lower dose. Permanent discontinuation is not necessary for a first episode. G-CSF would not be appropriate in this context.

Reference: BSR 2025 - Guideline for prescription and monitoring of conventional synthetic DMARDs